C-section

Teresa's Birth

Teresa and her husband Jared really wanted to have a natural birth. They got pregnant in the spring of 2011 with twins. Teresa and Jared lost the twins and were not trying at all when they found themselves pregnant again the next month. From the very beginning Teresa was very proactive about her care and insisted that the doctor check her thyroid level. Her OB did and found that it was off. So, this time with the proper medication, her pregnancy stuck. However, this was not an easy pregnancy. Teresa had hyperemisis and could not hold any food down. She had an IV at home during her first trimester.

Once the throwing up started to slow down and Teresa was off the IV, she started looking into doulas knowing that she wanted a natural birth. I met Teresa and Jared very early on in her pregnancy. I really liked them right away, we really seemed to click. We did talk a lot about her concerns during our interview, but she still was looking into having a home birth. I recommended they take Bradley classes because Teresa and Jared really wanted to know all they could about natural birth and Jared really wanted to be a big support for her. Bradley seemed to be the best fit for them.

A few months later, I got a call from Teresa and Jared that they wanted to hire me as their doula. By this point, she was diagnosed with gestational diabetes. When we had our first prenatal visit, we talked a lot about nutrition. I wanted to make sure she was eating her protein to prevent pre-eclampsia and eating a proper diabetes diet. Teresa was very concerned about the insulin because after she would take it her baby would have long periods of no movement. She decided to take her care into her own hands because the doctor treated all patients the same and she managed her diabetes with diet and exercise.

At our next visit, Teresa told me she found out she had very low platelets. By this time, they knew she wasn't going to have a natural birth and had chosen a doctor. Their doctor seem to really respect their wishes and she really listened to Teresa's concerns. When the doctor told them Teresa had low platelets, she also told them that she would not be able to have an epidural and they would avoid a c-section as much as humanly possible. Teresa was very happy about her doctor's approach to this.

For the remainder of the pregnancy, the doctor payed close attention to her swelling, blood pressure and took labs to check liver enzymes. She also consulted with a high risk doctor. In taking all these precautions, Teresa's OB was confident that she hadn't developed pre-eclampsia. Teresa's biggest concern was the possibility of bleeding out.

At Teresa's 39 week appointment her blood pressure spiked, so her OB sent her into the hospital for some tests. Everything looked good and they sent her home. The following week at her 40 week appointment the same thing happened. It was Monday morning, this time when she went in for test she told her husband to go get some things done and to pick her up later. At this point they called me and told me what doctor was on call. I knew immediately Teresa was not going to leave that hospital without a baby. Dr. Cortez, yes, I will name her because if anyone goes to St. Jude, they must be completely aware of how this doctor treats patients so they can be prepared, anyway, Dr. Cortez was on that day and I knew from another doula that she uses scare tactics, she tells the mom if mom doesn't do what doctor says, how she says it, "baby can die." She tells the mom, "Your baby might be fine right now, but in an hour all that could change." She always uses the line, "If you were my sister..." Needless to say when Jared called me, I told him what was going to happen. Sure enough, Dr. Cortez said word for word what I said. She also went on to tell Teresa she was "Severe Eclamptic" and she could "seize and die if they didn't get her baby out fast." At this point, Teresa's blood pressure was normal and all the labs were coming back normal except for the platelets. Dr. Cortez also told Teresa, "There will be no acrobatics in labor because if you slip and fall and crack your head open, I am liable." She took Teresa's birth plan and scribbled her notes next to everything she wasn't going to let Teresa do and crossed out the rest. Dr. Cortez's plan was to induce labor by inserting a foly bulb, when it fell out she wanted to start a high dose of pitocin and "get her in pain, real pain because she needs to be in pain to get this baby out" and have the baby by midnight that night.

Teresa was in tears, feeling completely scared, angry and untrusting of anybody in the hospital. I encouraged her to call her doctor. Her doctor told her over the phone that she didn't think she was severe eclamptic, but she did have to wait for labs. Her doctor said if everything is fine, baby looks good and blood pressure is good, they do not need to rush labor. So, Teresa waited a few hours and decided to get prepidil on her cervix to try and soften it. When she was admitted to the hospital she wasn't even 1 cm. Once Dr. Cortez realized Teresa wasn't going with her plan, she refused to do anything. She said she wouldn't do anymore jell after the first dose because it won't work.

Teresa just waited till the next doctor came in. Tuesday morning when the next doctor, Dr. Buchannan came in, he really listened to Teresa and her concerns and gave her honest answers. He said she was NOT severe eclamptic and she could take the induction as slow as she wanted. Teresa chose more prepidil. Dr. Buchannan did 5 doses that day and through the night. None of it softened or dilated her. At this point Teresa was still very untrusting of the staff and doctors.

Wednesday, Teresa's doctor, Dr. Su was on call. Dr. Su also said Teresa wasn't sever eclamptic and she probably wasn't even pre-eclampsia. Her platelets were still a concern, but her blood pressure and liver enzymes were perfect also, the baby was doing wonderful. We are now at the third day and Teresa decides to do the foley bulb. Dr. Su inserted it and a few hours later it fell out like it was supposed to at 4 cm. Then Teresa decided to start the pitocin. They started at 1 ml and gradually went up to 12 ml. It was on this day that Teresa finally expressed to me that if she has a vaginal birth, she will get to meet her baby right away and if she bleeds out and dies, she will have at least gotten to meet her baby. But, if she had a c-section, she would have to be put under and if there were complications and she bleed out, she would never get to meet her baby.

Teresa never dilated again and her contractions never got a real consistent, strong pattern to them. At this point Teresa was getting worried about when Dr. Cortez was going to be on call again. She was told that Dr. Grey would be in the following day, Thursday.

Here we are at Thursday and Teresa still has not progressed. Thankfully her baby was doing beautiful the entire time. Dr. Grey comes in and has an honest talk with her, he tells her he will do what ever she wants and there is nothing to worry about unless things change with her or her baby. Teresa decided she wanted him to break her water. He did that around noon and 4 hours later she did not dilate and her baby did not move down. Teresa and Jared decided that in this situation, labor was not going to happen. She decided to go ahead and have a c-section.

They took her in for the c-section around 5 pm. There were some minor complications, her blood pressure spiked after and she took quite a while to come off the anesthetic. She was in recovery for hours, but Teresa and Jared had a beautiful 8 lb baby boy Thursday, February 9th, 2012.

In the end, Teresa had peace about her decision. It was a decision she made in her own time without being told what to do. She got to make that call when she was ready. There were no what if's after. She knew she tried everything possible to have a vaginal birth, in the end, she was happy to have the experience over and have her beautiful little boy nursing in her arms.

Wende's Birth

I met Wende a few weeks before she was due. She had just moved to CA from Massachutes where her, her husband and their daughter had been living for a few years. Before that they lived in the Netherlands. I received an e-mail from her saying that she needed some help during labor because they are new to the area and don’t have any friends or family to watch their daughter so her husband will not be able to attend the birth of their second daughter. We talked and decided to meet at a restaurant to see if I could help her. Right away I loved her honesty and openness. She was very real. Wende told me she was induced with her first daughter, but didn’t have any other interventions. She didn’t want to have an epidural this time around either, she just didn’t see the point. I told her to talk with her husband and that I should meet him to, so we did that and they decided to have me as their doula.

It was November 2nd, Wende went in for her usual non-stress test (NST) that she did every Tuesday for the last couple weeks. She had been “uncomfortable” all night and couldn’t sleep. She though it possibly could have been contractions, but wasn’t sure. In the morning Wende told me she was having more discharge and at about 11 it was pink. I was pretty sure she was in early labor and was finally dilating, but I didn’t want to get her too excited, so I told her to go about her normal activities and to eat well. This was 4 days past her due date and during our first conversation she told me she was going to be early. Friday on her due date, she still was dilated to 0 cm. She wasn’t too excited about that.

The NST showed dips in the baby’s heart rate every time she had a contraction which were about 6 or 7 minutes apart. The doctor wanted to put her on pitocin to see how the baby would react to it. So Wende e-mailed me telling me they were going to induce her. I told her I’d just have to drop off my kids and I’d be at the hospital. I arrived at 3 pm and her husband was already there. Their daughter was in day care, so her husband was able to be there for part of the birth. The baby seemed to be doing good, no more dips in her heart rate and Wende was handling the contractions fine. She told us not to stop talking during a contraction at this point. Rudie, Wende’s husband had to leave to pick up their daughter, but a coworker of his said she could spend the night there, so he took her over there after they had dinner together.

While Wende’s husband was gone the contractions started to increase in intensity. Wende was still handling them beautifully, the only change was she wanted some quiet during them. A couple hours later, the monitor wasn’t getting a correct read on the baby. Her heart rate was showing 80, but when the nurse would listen by ear, it was sounding much higher. The nurse then decided to ask the doctor to rupture Wende’s membranes so they could put an internal fetal monitor in. Wende was told it would be a male doctor and she wasn’t too comfortable with this. I asked if they had a female and there wasn’t one available to do that. So the doctor comes in and breaks her water. This was probably the most difficult part of labor. Wende had a lot of trouble relaxing and it was painful to her. I think it was just a lot with the male doctor, a couple of nurses, she had to be on her back and the lights were very bright. All those sensations just lead up to a rough time for this part. After that Wende was able to get back into her rhythm with the contractions and she was doing wonderful again. But the baby’s heart rate was reading in the 250’s about 100 beats too high. There was no maternal fever and Wende’s heart rate wasn’t increased so there was really no explanation for this. They turned off the pitocin, re-did the internal monitor, used a hand held doppler to measure the heart rate and changed out the machine, but still 210 - 260. So they started talking to Wende about a possible cesarean.
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At this point I asked the nurse if they knew this happened a couple of weeks ago and they didn’t. They also couldn’t find it in her records. So now they were thinking it is just an arrhythmia in the baby’s heart. I called Rudie to tell him what was going on and there may be a c-section. At about 7:30 the doctor filling in for Wende’s OB came in to tell her the plan. This doctor was a female, that was good. Anyway, she said they need to do a c-section because they can’t monitor how the baby is doing with the contractions with her heart so high and if the baby needs medication for her heart, they can’t do it inutero. So I asked if they can wait for her husband to arrive and I also asked if the baby’s heart went back to normal if she can continue with labor. The doctor did not want to do that just incase. Rudie was about a half hour away so they said they would wait. Around 7:45 Rudie arrived and the baby’s heart was finally back to normal. So they went to have the c-section and Jill their new little girl was born at 8:42 pm, November 2, 2010. She was 8 lbs, 6 oz and 19 3/4 inches long. Her apgar scores were 9 at 1 minute and 9 at 5 minutes. Even through Jill had wonderful apgar scores and her heart was normal, the neonatal doctor wanted her monitored in the NICU for 24 hours. So Jill had to be separated from her mom for 24 hours.
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Now, 2 days later, Jill is doing wonderful, she was back with her mom just under 24 hours and she has started nursing and doing so well that Wende’s milk is in. Wende is feeling much better after her surgery, each hour she says, she feels better. It was wonderful that Rudie made it to be there for the birth of their daughter. They were both worried that he might have to miss it. Especially since it was a surgery she was able to have her husband there with her. Everything in God’s perfect timing. In the end, Wende prefers the vaginal birth because the recovery is better, but she liked that the c-section was very quick and easy. So what matters most is a healthy mom and baby.